The role of enteral nutrition in the treatment of protein-calorie malnutrition in cancer is not established. In the first two years of this project, abnormalities in glucose and protein metabolism including 1) increased postprandial whole body protein turnover; 2) increased whole body glucose production rates; 3) increased muscle catabolism rates; and 4) glucose intolerance were demonstrated in patients with stage III non-oat cell bronchogenic cancer compared to age-matched controls. In the proposed studies, the effects of these abnormalities on the anabolic response to continuous nasogastric feeding will be examined in patients with unresectable epidermoid head and neck cancer and carefully-matched comparably malnoourished control subjects with prior gastrectomy for non-malignant disease. Subjects in both groups will be studied under metabolic ward conditions to determine whether increased resting energy expenditure increased protein turnover, or abnormalities of carbohydrate metabolism impair the anabolic response of these cancer patients to continuous enteral alimentation compared to the control subjects. All subjects will be studied for ca. one month as inpatients and then for 4 days every 3 weeks while home enteral nutrition continues. Resting energy expenditure and whole body protein turnover will be measured simultaneously using a ventilated hood system and infusions of U-14C lysine and 1-14C-leucine. Muscle catabolism rates will be measured by 3-methylhistidine/creatinine excretion ratios. A number of hormones which could affect anabolism will be measured by radioimmunoassay. Changes in body composition and tumor mass will be measured. Abnormalities of insulin secretion and action will be investigated using a glucose-controlled insulin infusion system. In the second phase of this study individualized insulin regimens (previously shown to correct abnormalities in carbohydrate metabolism) will be tested in both groups of subjects using the same study design and methods. Based on a careful analysis of the data, both the efficacy of this nutritional regimen and the effects on anabolism of the adjunctive insulin therapy will be evluated in malnourished cancer patients and controls, and the impact of defined metabolic abnormalities on the anabolic response to nutrition assessed.